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Chapter 59

Chapter 59. Drugs Related to Hypothalamic and Pituitary Function. Hypothalamus and Pituitary. Related anatomically and functionally Regulate all bodily processes 15 hormones and regulatory factors. Overview of Hypothalamic and Pituitary Endocrinology. Hormones of the anterior pituitary

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Chapter 59

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  1. Chapter 59 Drugs Related to Hypothalamic and Pituitary Function

  2. Hypothalamus and Pituitary • Related anatomically and functionally • Regulate all bodily processes • 15 hormones and regulatory factors

  3. Overview of Hypothalamic and Pituitary Endocrinology • Hormones of the anterior pituitary • Growth hormone (GH) • Corticotropin • Thyrotropin • Follicle-stimulating hormone (FSH) • Luteinizing hormone (LH) • Prolactin • Hormones of the posterior pituitary • Oxytocin • Antidiuretic hormone

  4. Fig. 59–2. Negative feedback regulation of the hypothalamus and anterior pituitary.

  5. Growth Hormone • Biologic effects • Promotes growth • Promotes protein synthesis • Carbohydrate metabolism • Physiology • Regulation of release • Biologic effects • Promotion of protein synthesis • Effect on carbohydrate metabolism

  6. Growth Hormone • Pathophysiology • Deficiency • Pediatric: short stature • Adult:reduced muscle mass • Excess • Pediatric:gigantism • Adult:acromegaly • Treatment overview

  7. Growth Hormone • Therapeutic uses • Pediatric growth hormone deficiency • Pediatric non–growth-hormone-deficient short stature • Pediatric short stature associated with Prader-Willi syndrome (PWS) • Adult growth hormone deficiency

  8. Growth Hormone • Adverse effects and interactions • Hyperglycemia • Neutralizing antibodies • Carpal tunnel syndrome • Fatality in patients with Prader-Willi syndrome • Interaction with glucocorticoids

  9. Fig. 59–3. Regulation of growth hormone release.

  10. Acromegaly • Growth hormone excess • Pituitary adenoma • Clinical manifestations • Treatment • Surgery • Radiation • Somatostatin

  11. Somatropin (Humatrope) • 10 preparations available • Identical to human GH • IM or subQ administration

  12. Insulin-Like Growth Factor-1 • Mecasermin (Increlex) • Synthetic of natural insulin-like growth factor-1 (IGF-1) • Used in GH deficiency that is not responsive to GH treatment • Adverse effects • Hypoglycemia, hypertrophy of tonsils, intracranial hypertension, vomiting, arthralgia, otitis media, elevation of serum aminotransferases and lipids, overgrowth of fat, facial bones, and kidneys

  13. Prolactin • Produced by the anterior pituitary • Stimulation of milk production after parturition • Effects of hypersecretion (excessive secretion) • Females: amenorrhea, galactorrhea, infertility, possible delay of puberty in girls • Males: reduced libido and potency, galactorrhea, possible delay of puberty in boys

  14. Prolactin • Treatment for hypersecretion • Suppression of prolactin release • Cabergoline (Dostinex) • Bromocriptine (Parlodel)

  15. Other Anterior Pituitary Hormones • Thyrotropin • Thyroid-stimulating hormone (TSH) • Corticotropin • Adrenocorticotropic hormone (ACTH) • Gonadotropins • Follicle-stimulating hormone (FSH) • Luteinizing hormone (LH)

  16. Antidiuretic Hormone • ADH: also known as vasopressin • Promotes renal conservation of water • Works on the collecting ducts of the kidney to increase their permeability to water • Produced in the hypothalamus

  17. Antidiuretic Hormone • Therapeutic uses • Diabetes insipidus • Cardiac arrest • Postoperative abdominal distention • Preparation for abdominal radiography • Desmopressin for nocturnal enuresis (bedwetting) • Hemophilia A • Von Willebrand’s disease

  18. ADH Use with Diabetes Insipidus • Diabetes insipidus • Deficiency of ADH • Polydipsia (excessive thirst) • Excretion of large volumes of dilute urine • Treatment: ADH replacement • Desmopressin (agent of choice) • Vasopressin • Adverse effects • Water intoxication • Excessive vasoconstriction

  19. Antidiuretic Hormone Antagonist • Conivaptan (Vaprisol) • ADH antagonist • Used in short-term IV therapy for hyponatremia in hospitalized patients with euvolemia and/or hypervolemia • Monitor serum sodium closely owing to risk of hypernatremia • Tolvaptan • Oral vasopressin antagonist • Used to reduce hyponatremia in euvolemic or hypervolemic patients

  20. Oxytocin • Produced by hypothalamus • Stored in posterior pituitary • Two physiologic roles • Promotion of uterine contractions during labor • Stimulation of milk ejection during breast-feeding

  21. Drugs for Acromegaly • Somatostatin analogs • Octreotide and lanreotide • GH receptor antagonist • Pegvisomant (Somavert)

  22. Drugs Related to Hypothalamic Function • Seven regulatory factors in the hypothalamus • Have only three clinical applications • GnRH and its synthetic analogs: to treat prostate cancer and endometriosis and to induce ovulation • CRH: diagnose adrenal disorders • Somatostatin: acromegaly • Gonadotropin-releasing hormones • Leuprolide • Goserelin • Nafarelin • Gonadorelin

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